HomeMy WebLinkAboutFMC Application 9-20-21UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
Please nate that these are separate
individual tests and will be charged per
separate type test accordingly,)
PERMIT #
❑ ENHANCED LEAK DETECTION LINE TESTING
i
ElTANK TIGHTNESS UEL MONITORING CERTIFICATION
---_, -- - -- SITE INFORMATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852.-2171
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SB -989 SECONDARY CONTAINMENT
FACILITY NAME & NE # OF CONTACT PERSON
P i)t A -D
---- -- N— 0
ADDRESS
5% 4<)
OWNER NAME
TO OPERATE
OPERATOR NAME PERMIT
# OF TANKS TO BE TESTED: v IS PIPING GOING TO BE TESTED?
T A N K #
VOLUME
a
a
❑ YES
CONTENTS
❑ NO
- __--- - TANK TESTING COMPANY
TESTING COMPA -- NAME & PHONE # OF CONTACT PERS N
CAA �E mw R-0 MEmTA-(..-, , CaA Ak-L CC Ck ---
MAILING ADDRESS
NAME & H E# F TESTER O SPE A I P ` CERTIFICATION #
TE- HOD
CC
APPLICANT SIGN DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
j APPROVED BY DATE
f
FD2095 (Rev 09/20)